Pulmonary Embolism: The Daily PANCE Blueprint

Pulmonary Embolism: The Daily PANCE Blueprint

A 51-year-old female on hormone replacement therapy with active cancer presents to the ER with sudden dyspnea and chest pain. Vitals signs reveal BP 122/82 mmHg, HR 106 bpm, RR 20 breaths/min, SpO2 91%, T 98.4F. EKG shows T wave inversions in the precordial leads. Which of the following is the most likely diagnosis?

A. Bacterial pneumonia
B. Pneumothorax
C. Acute respiratory distress syndrome
D. Pulmonary embolism
E. Myocardial infarction

Answer and topic summary

The answer is D. Pulmonary embolism

The patient is having a pulmonary embolism. Risk factors include blood stasis (bed rest, travel), endothelial damage (surgery), and hypercoagulable states (hormones, cancer).

The most common symptom of a PE is shortness of breath. An EKG may reveal flipped T waves in precordial leads, sinus tachycardia, or the rare S1Q3T3 pattern. Work-up includes CTA chest, BNP, troponin, transthoracic echocardiogram, and possibly a hypercoagulable workup.

Treatment for a pulmonary embolism in a stable patient without signs of RV strain is anti-coagulation. A patient with a massive PE (unstable) should receive systemic tPA if there are no contraindications. People with submassive PE (signs of RV strain) can be considered for thrombectomy or catheter-directed tPA.

View blueprint lesson

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒ Pulmonary Circulation ⇒ Pulmonary embolism (ReelDx)

Also covered in the Emergency Medicine and Internal Medicine EOR content blueprint